Abstract
Background. Reoperative neck exploration for hyperparathyroidism is often difficult even for
experienced surgeons. Recent advances in preoperative and intraoperative localization
techniques have improved successful resection rates. This prospective study evaluates
the accuracy and clinical utility of intraoperative technetium 99m sestamibi scanning
for localizing hyperfunctioning parathyroid tissue in reoperative neck explorations.
Patients and methods. Eleven patients underwent reoperative neck exploration for hyperparathyroidism. Two
patients had 3 prior neck explorations, 1 had 2 prior neck explorations, and 8 patients
had 1 prior neck operation. Preoperative studies included sestamibi scintigraphy and
ultrasound in all patients, magnetic resonance imaging in 4, computed tomography scan
in 3, parathyroid arteriogram in 1, and selective venous sampling in 1. All patients
underwent intraoperative technetium 99m sestamibi scanning and parathyroid hormone
assay. Results. Preoperative technetium 99m sestamibi scanning and ultrasound each successfully localized
7 of 11 hyperfunctioning glands (64%). Intraoperative technetium 99m sestamibi scanning
correctly localized 10 of 11 hyperfunctioning glands (91%). Intraoperative parathyroid
hormone assay confirmed successful excision of hyperfunctioning tissue in all 11 patients.
Postoperatively, all 11 patients had low-normal or normal calcium levels. Conclusions. Intraoperative technetium 99m sestamibi correctly localized 91% of hyperfunctioning
glands compared with 64% localization for preoperative technetium 99m sestamibi and
preoperative ultrasound. Intraoperative technetium 99m sestamibi scanning and parathyroid
hormone monitoring are useful in reoperative neck explorations for hyperparathyroidism.
(Surgery 2000;128:744-50.)
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Article info
Footnotes
*Reprint requests: Richard A. Prinz, MD, Department of Surgery, Rush-Presbyterian-St. Luke's Medical Center, 1653 W Congress Parkway, Chicago, IL 60612.
**Surgery 2000;128:744-50
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
